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Abstract With the introduction of simple and harmless methods for the determination of the presence or absence of tuberculous infection, our knowledge of the prevalence of tuberculosis has made immense strides. The work of von Pirquet, Schick, Hamburger, Ghon and many others has taught us that tuberculous infection is common, much more common than we had previously believed; that its incidence in childhood increases as the age of the child advances; that tuberculous infection is by no means synonymous with tuberculous disease. Moreover, we are now in possession of much evidence which proves (1) that the respiratory tract is in a very large percentage of cases the portal of entry; (2) that the bronchial lymph nodes are the seat of tubercles in almost all children who react positively to tuberculin tests; and (3) that the great majority of cases of adult pulmonary tuberculosis probably depend on these very nodes for their References 1. An excellent compilation of the literature on this subject may be found in "La Tuberculose de l'Enfant" by L. Jeanneret, Paris, 1915. 2. The von Pirquet tests were made with undiluted old tuberculin, obtained from the New York City Board of Health Laboratory, a regular von Pirquet scarifier being used. For the intradermal tests an all glass hypodermic syringe and fine needle were used. Care was taken that the needle was thrust into and not under the skin, this being ascertained by the appearance of a tiny wheal as the solution was being forced between the layers of the skin. All tests were made on the flexor surface of the forearm, after cleansing with alcohol, and were read after a period of forty-eight hours, since it is generally conceded that any traumatic action has by that time disappeared. As these tests were carried out over a period of two years, it was obviously impossible to make use of the same solution of tuberculin for them all. Many of them, however, were done with the same solution, and in no child was different tuberculin used for the different tests; that is to say, the three von Pirquet and the three intradermic tests were always performed with the same stock tuberculin. 3. Veeder, B. S., and Johnston, M. R.: Am. Jour. Dis. Child. , 1915, 9, 478. 4. Holmgren, I.: Beitr. zur Klin. d. Tuberk. , 1912, No. (25) 5. Rachmilewitsch: Jahrb. f. Kinderh. , 1913, No. (77) 6. Entz: Wien. klin. Wchnschr. , 1908, No. (12) , and others. 7. Von Pirquet: Wien. med. Wchnschr. , 1913, 39, 2518. 8. Frehn: Beitr. z. Klin. d. Tuberk. , 1914, No. (32) . 9. Von Pirquet: Jour. Pharm. and Exper. Therap. , 1909-1910, 1, 174.
American Journal of Diseases of Children – American Medical Association
Published: May 1, 1918
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